Health-Care Disparities in the Use of Diabetes Technologies in the UK

Health inequalities have been a longstanding challenge for decades with widening disparities in recent years. Much focus is rightly placed on inequalities based on race/ethnicity, but it is clear that racial disparities and socioeconomic deprivation are interlinked. The connection between systematic and personal bias against individuals from the most deprived groups, irrespective of ethnicity, clearly exists. Socioeconomic deprivation appears to be an influential factor driving health disparities, with implicit bias directed against individuals living in poverty. This is reflected in access to diabetes technologies such as insulin pump therapy, continuous glucose monitoring systems, and automated insulin delivery where those from ethnic minority backgrounds and those in areas of highest deprivation are least able to access or benefit from such technological advancements. Inequalities are further reinforced by government cuts in spending. Between 2009 and 2020, net expenditure per person in local authorities in the 10% most deprived areas fell by 31% compared with a 16% decrease in the least deprived areas. These regressive cuts included a failure of health-care spending to rise in accord with historical patterns. Compounding the challenges were cuts to public health funding and reductions in welfare payments to families most in need. These widening health inequalities are unacceptable and unfair within a national health system where all individuals are entitled to the same level of care. Improved access to specialist diabetes care teams and to life-enhancing technologies could improve the health of all people with diabetes and reduce its human and financial cost.